One of the strongest risk factors for death in individuals undergoing cardiac surgery is Cardiac Surgery Associated-Acute Kidney Injury (CSA-AKI). Although the minimum kidney oxygen delivery index (DO₂i) during cardiopulmonary bypass (CPB) has been reported, the optimal threshold value has not yet been established. A prospective study was conducted from June 2012 to January 2016 to asses how DO₂i influences the pathogenesis of CSA-AKI, as well as its most favorable cut-off value. DO₂ levels were recorded at the beginning, middle, and end of the CPB. The association between DO₂i and CSA-AKI was investigated using multivariable logistic regression analysis. The optimal cut-off of DO₂i as a predictor of CSA-AKI was determined using Classification and Regression Tree (CART) analysis. A total of 782 consecutive patients were enrolled. Of these, 231 (29.5%) patients developed AKI. Optimal DO₂i thresholds of 303 mL/min/m² during the CPB and 295 mL/min/m² at the end of the intervention were identified, which increased the odds of CSA-AKI almost two-fold (Odds Ratio (OR), 1.90; 95% CI, 1.12–3.24) during the surgery and maintained that risk (OR 1.94; 95% CI, 1.15–3.29) until the end. Low DO₂i during cardiopulmonary bypass is a risk factor for CSA-AKI that cannot be ruled out. Continuous renal oxygen supply monitoring for adult patients could be a promising method for predicting AKI during CPB.

Aortic stenosis is the most prevalent primary valve disease in developed countries. Its prevalence is increasing due to population aging. Transcatheter aortic valve replacement (TAVR) is a sterling therapy for symptomatic patients with severe aortic stenosis and high or intermediate surgery risk. The number of procedures has increased exponentially expanding to younger and lower risk patients. Despite new-generation TAVR devices and enhanced operator skills, cerebrovascular events (CVEs) carry on being one of the most severe complications, increasing morbi-mortality. CVE might be under reported because there are few studies with rigorous neurological clinical assessment. Several imaging studies show most of CVE after TAVR has a probable embolic etiology. The risk of CVE ranges from 2.7% to 5.5% at 30 days. As TAVR expands to younger and lower risk patients, the prevention of stroke plays an increasingly important role. Cerebral protection devices (CPD) were designed to reduce the risk of CVE during TAVR. This review describes the scientific evidence on CVE after TAVR and summarizes the performance and results of the main CPDs.

OBJECTIVES: Surgical aortic valve replacement (SAVR) changes the natural history of severe aortic stenosis. However, whether the life expectancy of patients with severe aortic stenosis undergoing this surgical procedure is fully restored is unknown. The objective of this study was to assess if the life expectancy of patients aged >75 years is fully restored after undergoing surgery for severe aortic stenosis. METHODS: We compared long-term survival of a group of patients aged >75 years, who underwent SAVR at our institution with the long-term survival of the general population. We matched each patient with 100 simulated individuals (control group) of the same age, sex and geographical region who died as indicated by the National Institute of Statistics. We compared survival curves and calculated hazard ratio (HR) or incidence rate ratio. Statistical significance existed if confidence intervals (CIs) did not overlap or did not include the value 1, as appropriate. RESULTS: Average life expectancy of surgical patients who survived the postoperative period was 90.91 months (95% CI 82.99–97.22), compared to 92.94 months (95% CI 92.39–93.55) in the control group. One-, 5- and 8-year survival rates for SAVR patients who were discharged from the hospital were 94.9% (95% CI 92.74–96.43%), 71.66% (95% CI 67.37–75.5%) and 44.48% (95% CI 38.14–50.61%), respectively, compared to that of the general population: 95.8% (95% CI 95.64–95.95%), 70.64% (95% CI 70.28%–71%) and 47.91% (95% CI 47.52–48.31%), respectively (HR 1.07, 95% CI 0.94–1.22). CONCLUSION: For patients over the age of 75 years who underwent SAVR and survived the postoperative period, life expectancy and survival rates were similar to that of the general population.

Revascularization strategies in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease: urgent or staged?